Author Archives: Paula L Wilson, RHU, REBC

About Paula L Wilson, RHU, REBC

Insurance and Employee Benefits, business owner, wife, mother, grandmother. Specializing in Employee Benefits, Personal Life, Disability and Long Term Care Insurance. Registered Health Underwriter, Registered Employee Benefit Consultant, Past President Orange County Association of Health Underwriters 1991, Past Vice President California Association of Health Underwriters, Past Legislative Chair of the National Association of Health Underwriters. Recipient of the Provencio Award for Excellence and Leading Producer Roundtable Award Recipient

Free steak for everyone!

January 1, 2013.   Today President Obama signed a bill that will entitle all Americans to free steak.   The OMB estimates the cost at $100 Billion over the next ten years.

June 1, 2013.  Today the OMB revised the estimate on the steaks to $230 Billion.   Previous estimates didn’t assume that people who previously couldn’t afford steak, would give it a try.  President Romney decided to tackle this projected deficit because he had already learned the lesson while Governor.

November 1, 2013,   Today the OMB revised the estimate on the steaks to $310 Billion.   Previous revisions did not predict that people would like the steak and increase their consumption of the steak.

January 1, 2014.   Today the OMB revised the estimate on the steaks to $370 Billion.  Damn vegetarians couldn’t stay on the wagon.

January 1, 2016.  Today the House passed a bill that rations steaks only to people that have grown or still have ALL of their own teeth.  One steak per person will be allowed each six months.  A queue will form for people who feel they must have steak and would like to appeal.

Ex-professional butchers, who had changed occupations when the government mandated a 90% reduction in their salaries, will volunteer to sit on the committee to review these appeals.

Today’s Headline: March 2, 2012.   White House increases estimate of the cost of ObamaCare by 30% or $111 Billion.   Earlier projections may not have accounted properly for the number of people who would shift from private market to the government subsidized private market plans.

Bending the Cost Curve: ACO’s – Maybe Ford was on to something

Maybe the American health care system of the past, where people were to be treated as individuals and doctors were allowed to consider each patients personal needs is inefficient.  It is certainly too inefficient to be allowed to go on, so say the academics trying to change a system they know nothing about.  Certainly all aspects of the American health care system are under attack, but the rubber hits the road when you turn into a number and your doctor won’t even be allowed to consider you anything more than a statistic that needs to be pushed to the next column.  Maybe Ford was on to something when he invented the assembly line.

John Goodman of the National Center for Policy Analysis, posted this blog at the NCPA website where a physician is describing what it is like to work within an ACO.  Accountable Care Organizations, the panacea of efficiency for Medicare patients under PPACA.

She states:

I am a Board-certified general internist. I worked for many years for…an Accountable Care Organization. It was factory work: we were interchangeable cogs in a vast machine.  The people who saw patients, especially “primary care providers” like me, were at the base of the pyramid and the bottom of the pecking order.

The future is clear. The management of the ACO — professional administrators, and physicians who see few if any patients — will schedule every moment of every primary provider’s day, critique every decision, continually scrutinize and evaluate every aspect of one’s practice. At my ACO, yes, we were on teams, but given no time to communicate with one another. We were forced to complete clunky electronic records we had no time to read. Despite years of training and experience, we had no input to the system that controlled our lives. We were not respected as professionals. It was demoralizing.

The health policy elite appears to have concluded that the crux of the problem is primary care practitioners, internists included, who are largely ignorant, lazy, and indifferent to their patients’ welfare, and oppose change of any kind. We do not know or care that a diabetic’s hemoglobin A1C should be below 7.

Therefore, we need tight supervision, complex systems of financial incentives and penalties, and frequent “feedback” about our deficiencies. We need electronic records to remind us that our female patients are due for mammograms that we should advise smokers to quit. And we must reach our goals efficiently, using the minimum number of those expensive tests, and managing large panels of patients.  (So we can’t spend much time with anyone.)

I highly advise everyone to set down the burger and fries, get to the gym and plan to be healthy until you drop.  It’s a wonder why we are starting to feel the effects of a primary care physician shortage.  Obamacare isn’t going to do anything to make medical practice any more attractive to our best and brightest.   The best and the brighest that would normally be attracted to Primary Care medicine don’t want to be part of an assembly line.  For that matter, neither do I.

Bending the Cost Curve: Improving Medication Adherence

It may not seem obvious to most, but NOT taking your medication contributes to one of the largest reasons for increased national health care costs.  According to the a 2011 NEHI study, improving patient medication adherence could reduce wasteful spending by $290 Billion.  Of the 187 million Americans taking one or more prescriptions, it is estimated one-half do not take medications as prescribed.

Not taking medication costs over $100 billion in excess hospitalizations.   The most expensive offenders are diabetics and hypertension patients.  A non adherent diabetic spends more than twice as much one that properly manages their disease as instructed.  They also run a 30 percent chance of hospitalization each year compared to 13 percent by their adherent counterpart.

Poor adherence to medication occurs for many reasons.  High out of pockets costs, lack of care coordination and follow up as well as co-morbidities such as severe or persistent mental illness.   Often medications are not taken as prescribed simply due to lifestyle, culture and belief systems.

Solutions revolve around improving care coordination and enhancing patient engagement and education.  With the rapid increase and improvement in the area of HIT (Health Information Technology), managed care programs have really jumped on the bandwagon agressively by reaching out to high risk members to ensure medication adherence and education.   At a very minimum, we see all insurers offering assistance through programs for patients that want to participate responsibly toward better health.

In the end, each individual must become responsible for themself in this area of medication adherence.   We must spread the word that not doing so will continue to escalate the rise in health care costs.

Bending the Cost Curve: ER Overuse

NEHI (New England health Institute) recently published a paper outlining the results of their research that not only points out $700 Billion in needless health care spending annually, but offer solutions to health care providers and the consuming public on how to reverse this trend.

$38 billion is attributed to overuse of ER departments.   This translates to 56 percent of all emergency room visits. This particular assertion hit home for me as a long time insurance agent because it has always been our number one customer service call.  Insureds looking for payment on $1,500 to $5,000 non emergency services rendered by the emergency room. Of course the study isn’t concerned with the bill getting paid but about eliminating the charge completely from the annual national health care expenditure.

The problem is that patients don’t understand the cost.  Even if you are simply using the ER for an ear infection, you are incurring an average charge that is $580 over the cost of the a normal office visit.   The study found that use of the ER for non emergency purposes spreads across all age groups regardless of the level or type of insurance. 

Patients admit they use the emergency room because it is a place to receive immediate care, instant access to all diagnostic tests and feedback before you leave the building.  This instant reassurance isn’t something you can get in one office visit.  The solution hovers around addressed those points.  That is why we see Urgent Care offices popping up in close vicinity to ERs.   Even markets and pharmacies are opening walk in clinics.  Insurance companies offering 24 hour nurse lines are standard but perhaps not used enough.   Even Doctors On Call, allowing phone access to a doctor 24 hours a day has become a popular part of our product line.  The alternatives are there, educatingthe public on the problem, it’s costs, and the solutions are the task everyone can work on now.

Emergency rooms are expensive to setup and and maintain.  They are full of expensive equipment and personel and done so based on expanding demand for services.  Once you hit the emergency room, defensive medicine is going to push those expensive assets into use.  Until the public gets involved and recognizes how society as a whole is pushing up the health care bill, prices aren’t going down anytime soon.

Maternity coverage – The California Mandate

Yes it’s true.   All individual and group  medical insurance policies (old, existing, recent and new) MUST include include maternity benefits on or before July 1, 2012.  There is no need for anyone to change policies to obtain the full maternity benefits. No one needs to apply or transfer their coverage to obtain full maternity benefits.  No medical underwriting can be required for in-force policies.

What will happen to your insurance costs?  I am sure you will see an increase but how much remains to be seen.   Those of us “stuck” in plans that include maternity coverage we don’t need could see a flattening of our rates.  With this new risk being spread across the entire market, unlike it ever has been before, the impact may not be so severe.

As an agent I have mixed feelings about the mandate.  Because there are only a handful of policies available on the market that include maternity coverage, it would have been a short time until those would have suffered so much adverse selection that we were about to have no coverage for an individual trying to purchase coverage outside of the group market.  I truly think a complete lack of coverage would impact how much basic care pregnant women would have foregone.

Carriers are still holding back new business rates for July.  I’ll let you know how this affects the market as the mandate takes hold.